ICU rotation takeaway: ‘Medicine is more than finding health’

Working with the hospital’s sickest patients gave Paul Pikman, OMS III, perspective on critical care.

Just after 6 a.m., as I was walking to start another day of my rotation in the ICU, a patient presented in cardiac arrest. After ten minutes of CPR, his heart started beating again on its own.

In the hours that followed, our team worked to stabilize the patient, understanding that the likelihood of survival was low given his history. Although the attending physician indicated that the patient was unlikely to recover, the man’s family elected to continue life support in hopes of a miracle.

After two weeks of mechanical ventilation and despite his extremely poor prognosis, the patient woke up. In the subsequent days, he was able to squeeze my fingers a little more each day. On the final day of my rotation, though he was still intubated, I watched him breathe on his own.

Choosing the ICU

For many third-year medical students, the ICU is an intimidating place. The constant beeps of the monitors, the loud alarms of the ventilators, the various tubes resembling spaghetti, the trauma of performing bone-breaking CPR compressions can all—understandably—rattle a medical student.

During rounds made up of large interdisciplinary teams, it can be unnerving to present patient cases, with the inevitable student mistakes appropriately challenged by more experienced team members. But after a few weeks I was surprised to find that the ICU rotation was rapidly becoming my favorite.

The ICU experience offered the opportunity to take care of the sickest patients in the hospital.

Perhaps the most difficult aspect of the third year of medical school is making a decision about what specialty to pursue. I strongly considered family medicine, anesthesiology and surgery. But the ICU experience offered something else: the opportunity to take care of the sickest patients in the hospital.

One was critically ill with HIV, presenting to the ICU with a severe gastrointestinal hemorrhage. She was deteriorating in front of our eyes as we donned our gloves and prepared to perform CPR, anticipating a poor outcome.

But at that moment, the attending physician walked in and informed the team that the family had elected to allow the woman to pass naturally. I walked away saddened, but appreciative that the patient passed without additional pain.

Joy and grief

At the end of my ICU rotation, I started telling friends and family about my decision to enter an internal medicine program and then pursue fellowship in critical care. I loved waking up every morning knowing that some critically ill patients would go on to recover. I would feel their joy, and feed off their renewed energy. But I also knew some patients would have less fortunate outcomes. In those situations, I would feel what the family feels, and see what they see, knowing too well the grief that comes with the death of a loved one.

Even in death, a health care team has the responsibility to ease pain and provide comfort.

A friend asked, “Do you start to feel numb to death?” No—it stings every time. But in the ICU I learned that medicine is far more than just finding health. Even in death, a health care team has the responsibility to ease pain and provide comfort. There is a sense of dignity and humility in providing relief to the patient and the family.

Perhaps what I learned most from this ICU rotation is that there is an inherent dichotomy in medicine. We have this great ability, and responsibility, to heal. But we must also recognize our limitations when confronting nature and manage expectations through education.

Bill Carnett

Paul,
Go for it. Critical care is what attracted many of us to medicine. Stick with it. Sure there are many more emotional “downs” with the continous poor outcomes in these settings, but this (ICU) is what medicine is all about. Don’t get side tracked and do the primary care thing….you’ll regret it later on. Follow your heart….whether it be critical care or primary care, but be honest with yourself.

….no, that’s not a dig at primary care. But you need to decide, spend your days seeing lots of patients, 80%+ who have no significant organic illness but a boat load of functional issues, or, all day with patients that are terribly ill, will likely suffer and die, but you still can give them the benefit of your training and skills to make the comfortable, and sometimes improve their health. Like it or not, medicine is about pathology and the associated illness. Nothing more fun than trying to get that “train wreck” back on the tracks :)